International Resuscitation Network Registry: design, rationale and preliminary results☆
Introduction
While there has been a steady decline in morbidity and mortality from most cardiovascular diseases over the last 30 years [1], [2], [3], [4], there has been little improvement in survival from sudden cardiac arrest. Also, there is a lack of high-quality information about the effectiveness of resuscitation interventions after out-of-hospital cardiac arrest [5] and uniformly collected data that enables comparisons between different emergency medical systems and countries [6]. An internet-based international registry could make such comparisons possible, and enable the conduct of large randomized controlled trials of resuscitation therapies.
We present here the design and initial observations of such an international registry, the International Resuscitation Network Registry (IRN Registry). Although these preliminary results are not representative of the true situation in the participating sites, they illustrate that it is feasible to prospectively collect uniform data describing outcomes after cardiac arrest in multiple international sites. We confirm that structure, process and outcome after cardiac arrest differ among international sites. Finally, we demonstrate the feasibility of a simple methodology that would facilitate the conduct of large simple randomized trials of promising resuscitation interventions.
Section snippets
Design
Multisite prospective cohort study (Appendix A).
Population
Infants, children and adults with out-of-hospital sudden cardiac arrest.
Setting
Goteberg, Sweden; Oslo, Norway; Perth, Western Australia; Richmond, Virginia, USA; Toronto, Ontario, Canada and Wilmington, Delaware, USA.
Inclusion criteria
Individuals who experienced out-of-hospital cardiac arrest requiring chest compressions or external defibrillation, on whom resuscitation was attempted by EMS personnel. Cardiac arrest was defined as lack of responsiveness, breathing or
Results
Enrolled subjects had cardiac arrest between March 1996 and November 2003. The five participating sites served populations of median 517,401 (interquartile range 470,787, 1,600,125) by responding to median 33,161 (interquartile range 27,643, 60,090) calls annually (Table 1). The skill level EMS providers varied from center to center, consisting of basic life support and defibrillation and/or advanced cardiac life support.
Five hundred and seventy one patients with out-of-hospital cardiac arrest
Discussion
To the best of our knowledge, this is the first, prospective web-based international registry of consecutive cases of out-of-hospital cardiac arrest. Participating sites were able to provide de-identified data in compliance with confidentiality regulations that was more than 95% complete for the majority of Utstein criteria. Therefore, it is feasible to collect standardized structure, process and outcome data relating to cardiac arrest in international sites. This enables description of
Conclusions
To the best of our knowledge, this is the first web-based study to collect data prospectively describing structure, process and outcome associated with cardiac arrest in multiple international sites. Such data collection is feasible. Our results demonstrate that it is feasible to collect prospectively uniform data describing outcomes after cardiac arrest in multiple international sites. We confirm that structure, process and outcome after cardiac arrest are highly variable among international
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A Spanish and Portuguese translated version of the Abstract and Keywords of this article appears at 10.1016/j.resuscitation.2004.12.019.